


Outpatient wound care in 21st century United Kingdom

by tessismad



Category: James Bond - All Media Types, Kingsman: The Secret Service (2015), Merlin (TV), Sherlock (TV)
Genre: Gen
Language: English
Status: Completed
Published: 2015-07-29
Updated: 2015-07-29
Packaged: 2018-04-11 22:51:26
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 1,263
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/4455551
Author URL: https://archiveofourown.org/users/tessismad/pseuds/tessismad
Summary: <blockquote class="userstuff">
              <p>For potential patients under the care of John Watson, Q or Merlin (although the magic will make things very much easier!), or other heroes who get shot, knifed or otherwise injured in modern fanfic and don’t like hospitals</p>
            </blockquote>





	Outpatient wound care in 21st century United Kingdom

**Author's Note:**

> _In a lot of fanfics I read which involve characters being shot (but it’s only a flesh wound!), stabbed or otherwise pierced, there are huge amounts of antibiotic ointment, gauze and bandages used, which are then changed at least once a day._
> 
>  
> 
>  
> 
>  
> 
> _This is not the current best method of treating wounds in the UK (or probably the rest of the world either) when the person doing the caring has the knowledge and access to appropriate dressings to take an up-to-date approach._

 

It is highly unlikely that Sherlock Holmes, James Bond, Harry Hart, modern King Arthur or anyone else would manage to get themselves injured under sterile conditions, so – on the assumption that said wound is at high risk of being contaminated:

 

1\. Clean. 

This is likely to be painful as it involves a lot of prodding and/or friction to remove dirt, fragments of clothes, other people’s bodily fluids etc.  
If your super hero isn’t a particularly tough guy, local anaesthetic is the answer. This is injected around the site of the wound in a similar way to how a dentist numbs your mouth before doing painful procedures. It takes a few minutes to work.

When numbed, the wound can be opened up for visual inspection and thoroughly cleaned with an antiseptic such as aqueous iodine or aqueous chlorhexidine. A little bit of bleeding can be a good thing to help flush out bacteria. Head wounds bleed a lot – out of all proportion to the actual size of the wound. Hair around the wound will need to be shaved so that the wound can be seen properly and dressings can be stuck in place.

When the wound is clean, any excess bleeding needs to be brought under control by applying pressure, then the skin around the wound needs to be clean and dry.

 

2\. Stitches.

If the edges of a wound don’t hold themselves together without help, or the part of the body which is injured is unlikely to be kept still, then yes, the wound needs stitching. 

On the face, steri-strips are used whenever possible to hold the wound together, as any scar that is formed will be neater.

Non-dissolving stitches are used in sufficient quantity to hold the wound together without any gaping. They are generally removed after one week, unless the area of the body is particularly prone to stretching, twisting etc, when they might be left for 10 days. 

They will itch when the scab that forms along the wound dries out.  
A competent person can remove stitches with no further bleeding from the site. So long as this is the case and the whole wound is dry, no dressing is required after the stitches are removed, unless the area is prone to rubbing eg from a collar or waistband. 

 

3\. Choice of dressing.

A dressing is not always necessary. If a wound is unlikely to be knocked or come into contact with dirty surfaces and it is clean and dry, it may be better to leave it open to the air to heal.

The purpose of a dressing is to protect the wound from knocks and becoming infected, and provide the ideal circumstances for tissue healing underneath.  
Modern surgical dressings don’t stick to the surface of the wound, allow water vapour and gases across the membrane, and some are water resistant so they can be left in place while the patient has a shower. They generally aren’t capable of keeping water out for a prolonged soak in a bath.

It is my personal opinion that the carers of the likes of Sherlock or James would choose waterproof dressings that would not need to be changed every time a shower was taken. 

Brands available in the UK include Tegaderm and Mepore pads which have an absorbent pad in the middle attached to a see-through, adhesive film dressing. They are waterproof , very flexible and, in theory, can be left in place for up to seven days. In practice, they should be changed after the first 24 hours so that the wound can be checked for infection and that it has dried properly, and then every three days afterwards provided it is healing properly. There is no need to cover these dressings with bandages or anything else.

If the wound needs cleaning again, it should be flushed only with a sterile “normal saline’ solution and nothing else – and then dried thoroughly with a sterile absorbent product. NO OINTMENT OF ANY KIND CAN BE APPLIED UNDER THESE DRESSINGS. A new dressing is then applied and left alone for 3 days.

 

4\. Antibiotics.

I think that a specialist in acute trauma like John Watson would choose to use high, single dose preventative antibiotic treatment, given as soon as possible to prevent infection getting a hold. All gun-shot wounds and any other visibly dirty or contaminated wounds would be treated by a single injection of an appropriate drug so that he could be sure that Sherlock got it all; and an oral course of treatment would be started if there were any sign of infection having taken hold.  
Q’s emergency medical kit would probably also contain an injectable antibiotic that he would have been trained by MI6’s medical staff to use properly (because of course they know that James gets help from Q). He would have a course of oral treatment available too – which James would consent to take because it was a better option than the medical department.  
If you give James the antibiotic called metronidazole (if he has had surgery involving the guts, or to treat a nasty case of diarrhoea when he has been in a third-world country, for example), he must not drink alcohol because it will make him very poorly including facial flushing, swinging changes in blood pressure, abdominal pain, and vomiting.  
Although it is not recommended to drink with other antibiotics, he will probably get away with it!

 

SPECIAL CASES. 

 

1\. Gun shot wounds.

If Sherlock gets shot, John has sufficient experience to decide whether the wound is superficial enough for him to treat, or if hospital is unavoidable.  
Bullet wounds are never clean and cause a lot of damage to tissues because of their velocity and heat. Anything that penetrates into the body will require hospital treatment. Even a very superficial flesh wound will be contaminated and will ‘weep’ a lot because of the damage to the cells. Specialist dressings that can cope with a lot of infected exudate are available.

When James Bond has been shot in another country several hours or days previously, he is likely to have tried to stitch it himself and the bullet may well still be in the wound. It will be infected and will probably need the source of the infection (bullet or other contaminated material) removed surgically. Q will not be able to deal with this on his own. He will, however, be able to keep an eye on the dressings and make sure James takes his antibiotics when he discharges himself against medical advice.

 

2\. Burns.

The first treatment is to cool the burn down by putting the affected area under a running, cool tap. It is the same treatment for Sherlock’s chemical burns. The area should be kept under the tap for long enough for all the tissues around the burn site to have cooled down. If the skin is badly blistered, a clean plastic bag or layer of food film can be loosely wrapped around the affected area before getting medical help.  
John will almost certainly have silver sulphadiazine cream in his emergency kit which is applied thickly when a burn is extensive and runs a high risk of becoming infected.  
Under no circumstances will John allow any other ointment or butter be applied to the burn – the oil in these products causes the cooking to be prolonged!

If a burn is extensive, even John would not attempt to treat it at home – apart from being extremely painful, the skin damage can lead to all sorts of serious problems that require intensive care and 24 hour monitoring.


End file.
